Reporting, discussing and interpreting sex differences in clinical and biomedical research has become a more complicated task in recent years, but necessarily so. Achieving clarity around what constitutes sex and what is associated with gender provides few conclusive answers and far more questions. As cogently expressed by Beans Velocci, a historian of sex and science, in a recent piece in Cell on sex as a scientific category, “…because it is so many things at once, all we can say for sure about what sex is is what a given scientist does with it” (B. Velocci, Cell 187, 1343–1346; 2024).